An Innovative Emory Cardiothoracic Surgical Treatment

August 9, 2010, 11:26 am By Dr. Puskas

Imagine experiencing atrial fibrillation (A-Fib), or a quivering of the heart, half of each day, every day. Now imagine a solution—and it doesn’t involve open-heart surgery. The only after effects: a few half-inch marks beneath your armpit accompanied by a new approach to life.

In one anonymous case study, a 46-year-old female executive had suffered from seven years of disabling A-fib, and described how the symptoms of her condition resulted in “zero quality of life.” She was unable to participate in numerous medication trials due to a variety of negative reactions to anti-arrhythmic medications, and she underwent two unsuccessful percutaneous catheter ablation procedures out-of-state.

After thoroughly researching multiple surgery options across the region, she agreed to be Emory’s first patient for a trial of a “Totally Thorascopic Mini-Maze”, involving a fully endoscopic approach to bilateral pulmonary vein isolation, a procedure utilizing bipolar radiofrequency energy and “stapled occlusion” of the left atrial appendage procedures.

On February 14, the patient received three tiny incisions in her chest on each side of her armpit. We made no other incisions, and a thorascopic camera provided our only visualization. At the beginning of the procedure, we carefully measured the exit and entry areas across the pulmonary veins on each side. Electrophysiology measurements confirmed a conduction block across the pulmonary vein on each side.

We stapled the patient’s left atrial appendage shut with an endoscopic, or “no-knife” stapling device, a tool that safely closes the base of the left atrial appendage with three rows of staples and no incisions, thus reducing risk of hemorrhage. Consequently, the patient experienced very little blood loss, and the cosmetic results were ideal, as her three incision sites were hidden beneath her armpit.

The procedure allowed the patient to be discharged a mere three days after surgery, and she only experienced one single brief episode of irregular rhythm upon her return home. At both her 1-month and 3-month follow-up appointments, she showed no signs of A-fib. As part of our comprehensive follow-up, on the anniversary of her 3-month visit, we provided her with a small, portable cardiac rhythm monitor that she used for two weeks to record her heart beat 24 hours a day. The monitor also documented a complete absence of A-fib.

We’re thrilled with the success of this procedure—this pioneering patient, once disabled by severe A-fib symptoms, is enjoying life once again. For carefully selected patients, this procedure could very well be an ideal solution.

If you have questions about this procedure, or about A-fib in general, I’m happy to address them in the comments section below.

About John D. Puskas, MD:

Dr. Puskas specializes in adult cardiac surgery. He began performing coronary bypass operations on beating hearts without using a heart-lung machine in 1996. In 1997, he performed the world’s first triple off-pump bypass surgery using minimally invasive coronary artery bypass graft (mini-CABG) instrumentation. Dr. Puskas is PI of a grant from the National Institute of Health’s National Heart Lung and Blood Institute that makes Emory one of eight U.S. centers charged with rigorous scientific evaluation of newer methods of fighting cardiovascular disease.

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